Healthcare Provider Details

I. General information

NPI: 1407561160
Provider Name (Legal Business Name): ZAVIER SHAWKAT AHMED MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17150 EUCLID ST STE 200
FOUNTAIN VALLEY CA
92708-4092
US

IV. Provider business mailing address

1669 SONORA CREEK LN
LAKE FOREST CA
92610-3020
US

V. Phone/Fax

Practice location:
  • Phone: 949-910-2076
  • Fax:
Mailing address:
  • Phone: 949-910-2076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ZAVIER SHAWKAT AHMED
Title or Position: CEO
Credential: MD
Phone: 949-910-2076